Supply of Medicines post #Brexit

SUPPLY OF MEDICINES FOLLOWING A NO-DEAL BREXIT

SITUATION AT 12 SEPTEMBER 2020

NOTES BY LEEDS HOSPITAL ALERT

Sources of information:

Cabinet paper: “Operation Yellowhammer: Government’s Worst Case Planning Assumptions” (11 September 2019).
Statements from the British Medical Association and the Healthcare Regulatory Authority.
Statement by Meg Hillier MP, Chair of Public Accounts Committee.
Audit Office report: “Exiting the EU: Supplying the Health and Social Care Sectors” (27 September 2019).
British Medical Journal articles dated 14 November 2018 and 20 August 2019.
Letter from Michael Gove, Chancellor of the Duchy of Lancaster, to Stuart Andrew MP, dated 3 October 2019, in response to his letter about supplies of medicines, dated 18 June 2019.

In addition: Leeds Hospital Alert was advised by Leeds’s Director of Public Health to send questions about the supply of medicines following a No Deal Brexit to the Ministerial Correspondence and Public Enquiries Unit at the Department of Health, and wrote on 20 February 2020. The Unit replied on 30 March to say that it could not answer the enquiry. A follow-up call to the Unit on 11 September revealed that the Unit “has no specific information” about the supply of medicines.

The Basic Problem and the Government’s Proposals

Three quarters of medicines used in the UK come from the European Union, mainly by the “Short Straits” route to Dover and Folkestone. After Brexit, access will be reduced to 40% – 60% of current supplies for up to six months.

The government proposes to deal with this in three ways:

Stockpiling: The government told medical suppliers in August to stockpile six weeks’ worth of medicines as a “buffer” against disruption when the Brexit transition period ends on 31 December.

New freight routes: the government has finalised a contract (£87m) with four ferry groups to bring in medicines on seven other routes rather than on the “Short Straits” route. There will also be aircraft chartered to bring in medicines with a short life, and a dedicated courier service.

Changes to Regulatory Requirements: using the government’s existing “Serious Shortage Protocols”, pharmacists will be able to provide alternative medicines of the same quality and pharmaceutical content, with different strengths up to the same dose; the therapeutic equivalent of any medicines not available.

Questions to the Government

Why is the proposed period for stockpiles planned for six weeks, when disruption of supplies is forecast to last six months?

The British Medical Association and the Royal College of Nursing have pointed out that “many medicines cannot be stockpiled”. What are the government’s plans for these medicines?

How will stockpiling work for medicines that need to be kept at a controlled, low temperature during transport and storage? These medicines include insulin and medicines derived from blood plasma. Sir Michael Rawlins, Chair of the Medicines and Healthcare Regulatory Authority, has expressed particular concern about the storage of insulin in stockpiling.

The Audit Office reported that ministers do not know if there will be enough freight capacity in place to cope. Will the government issue new information confirming that the capacity exists?

How will the new freight routes work? Which companies will be running them? How will medicines such as insulin be transported safely? What professional oversight will there be of the process?

When will the government issue information to patients and their families who are worried about the supply of medicines? Attempts to get information directly have not proved successful (e.g. correspondence with the Department of Health, quoted above). Diabetes UK states: “We are concerned that the government has not communicated its plans regarding the continued supply of insulin in the event of a no deal Brexit, which is causing unnecessary concern for people with diabetes”.

Matt Hancock, Secretary of State, has apparently refused to rule out that people could die because of shortages of medical supplies following a No Deal Brexit (Evening Standard, 15 November 2018). Does Mr Hancock still stand by this statement?

Brexit medicines

12092020

Yorkshire Health Campaigns Together meeting 1st May 2020

Yorks HCT mtg 1.5.20 final

Summary Action Agreed

  1. Push the “Test, test, test, PPE, Keep Key Workers Virus free” message. Gilda can send A4 rainbow poster on request and will pass on a new one 999 is preparing
  2. Consider taking the clap out from our streets to more public places such as outside hospitals, maybe even Social Care homes.
  3. Spread campaign re migrant charging (Leeds open letter attached)
  4. Press local and regional health and Social Care Scrutiny Boards to meet (Jenny writing)
  5. Start some serious campaigning for a national, free at the point of use, public national Social care service.
  6. Don’t lose sight of Trade deals and exert what pressure we can on our MPs et al
  7. Do all we can to support whistle-blowers
  8. Think creatively about co-ordinated celebration, protest, campaigning and maybe even marching in July. Possibly on the weekend of 4th and 5th and maybe 25th as well.

Nationalising Special Purpose Vehicles to end PFI: a discussion of the costs and benefits by Helen Mercer and Dexter Whitfield:

MERCER_Nationalising_Special_Purpose_Vehicles_to_End_PFI_2019

Important public meeting online, May 5th 7pm, Coronavirus crisis: What now for the NHS?

Speakers:

Richard Horton – Editor of The Lancet
Professor Allyson Pollock – Consultant in public health and director of Newcastle University Centre for Excellence in Regulatory Science
Dr John Lister – editor of Health Campaigns Together, co-editor of The Lowdown (Lowdownnhs.info)
Dr Sonia Adesara – Junior Doctor and member of KONP’s NHS Staff Voices group
Pam Kleinot – Producer of Under The Knife

This is an online meeting held via Zoom, an easy-to-use videoconferencing app.

Please register here: https://us02web.zoom.us/webinar/register/WN_SeVsKXHHRIa2fvHiDRZVJg

Join Keep Our NHS Public and Health Campaigns Together, to hear from expert analysts, frontline NHS workers and the producer of Under The Knife (feature documentary on the  covert dismantling of the NHS) to hear about how, aggravated by Government arrogance and failure in the early stage of the Coronavirus outbreak, the NHS has been defunded, understaffed and fragmented by privatisation to such an extent that it’s preparedness for the current emergency has been severely undermined and has needlessly cost lives.

Dr John Puntis in The Independent

https://www.independent.co.uk/voices/boris-johnson-coronavirus-uk-nhs-eu-symptoms-a9372526.html

As a doctor, I’m telling Boris Johnson – a Little Britain response to coronavirus will be deadly

We have long known that pandemics do not respect borders. If Johnson removes us from the EU’s disease response network, the consequences could be disastrous

In 1831, the first “Asiatic cholera” pandemic reached the UK via the port of Sunderland. Although the terrible nature of the disease was evident to local doctors, vested interests delayed the notification of authorities in London because of concern about negative effects on business. Of course, more people died, and the port was quarantined.

This cholera pandemic was probably the first time the international dimensions of managing a public health emergency became clear. With 90,000 coronavirus infections and 3,000 deaths worldwide, there is now a new spectre haunting the globe.

The Organisation for Economic Cooperation and Development warns that coronavirus could slash global economic growth rates in half, as factories shut down and supply chains are broken apart. Meanwhile, the European Union has raised the risk of infection from moderate to high.

The UK appears woefully unprepared for coronavirus. The NHS is already in bad shape, with the worst ever A&E waiting times, over 95% bed occupancy, 100,000 staff vacancies and the prospect that a no-deal Brexit will majorly disrupt the supply of medicines. With the worst-case scenario suggesting up to 50 million infections and up to 250,000 deaths in the UK alone, there can be little doubt that both health and social care services will be severely challenged by even a modest intensification of the outbreak.

More worryingly still, it appears the UK government is allowing petty infighting to hamper its preparations for a pandemic. It is staggering to hear that, as the virus continues its rapid spread, Downing Street and the Department of Health and Social Care (DHSC) are locked in a row about Brexit – specifically, the UK’s continued access to the EU Early Warning and Response System (EWRS) for communicable diseases. The DHSC, it is reported, wish to remain in the EWRS, the prime minister decidedly does not.

The EWRS was created by the European Commission to “ensure a rapid and effective response by the EU to events (including emergencies) related to communicable diseases.” In the web-based system – which links the European Commission, public health authorities and the European Centre for Disease Prevention and Control – appointed contacts in member states receive real-time notifications of emerging communicable disease threats, and proposed measures to control them. This allows prompt and coordinated action to fight outbreaks of infectious disease.

A number of organisations have attempted to steer the government away from the disastrous course of leaving the EWRS. The Brexit Health Alliance (BHA), for example, brings medical researchers, patient groups and public health bodies to safeguard the health service during Brexit negotiations. It argues that it is in both Europe and the UK’s interests to cooperate in handling public health issues, and BHA lists the EWRS is as an important mechanism for doing so – not that the government seems to care.

The Faculty of Public Health (FPH) is another expert body whose advice is being ignored. The FPH praised then health secretary Jeremy Hunt for acknowledging that public health emergencies transcend global boundaries, and for committing to making health security central to our Brexit negotiating position. These are commitments over which the government is now riding roughshod, and for what appear to be political reasons.

Under Johnson, Britain appears to be adopting similar isolationism in its public health policy as in its foreign policy. Yet we have known since at least 1831 that pandemics do not respect borders. A “Little Britain” approach to coronavirus is not merely unwise – it is dangerous. Fighting Covid-19 requires us to work with our European neighbours – if we do not, we are putting lives at risk.

The government’s plans to fight coronavirus include recruiting retired doctors like me. Yet domestic skills can be no substitute for international collaboration. As a former consultant paediatrician, I am asking Number 10: for patients’ sake, do not take us out of the EWRS.

Dr John Puntis is co-chair of Keep Our NHS Publlic

Letter for Parliamentary candidates – please use and share

Dear General Election Candidate,

HEALTH CARE: WHAT A BREXIT DEAL MUST INCLUDE

The British Medical Association has published a Briefing on what a Brexit deal must include to safeguard health care for people in the UK.

The Briefing calls for the following safeguards for patients and the NHS in any Brexit deal. Please let me know how once you are elected you will ensure that the government will implement each of these safeguards:

A Brexit deal must include:

Free movement for healthcare and medical research staff

Permanent residence for EU doctors and medical researchers currently in the UK

Continued rights for EEA medical students in the UK to live, train and work in UK health services

Continuation of the existing open border arrangements between Northern Ireland and the Republic of Ireland

Ongoing cross-border co-operation in the delivery of healthcare to patients on both sides of the border between Northern Ireland and the Republic of Ireland

Freedom of movement for healthcare workers to live and work on both sides of the border between Northern Ireland and the Republic of Ireland

Ongoing MRPQ (Mutual Recognition of Professional Qualifications) to provide doctors the means to move and work between both Irish jurisdictions

Ongoing participation by the Medicines and Healthcare Products Regulatory Agency in the regulatory framework for pan-European clinical trials

A formal agreement between the UK and European Medicines Agency to continue to support and participate in their assessments for medicine approvals

Mutual recognition of, and ongoing participation in, the CE scheme for medical devices

The retention, or comparable replacement, of reciprocal health care arrangements and access to healthcare for both UK and EU citizens

The maintenance of reciprocal arrangements, such as the MRPQ (Mutual Recognition of Professional Qualifications), to facilitate the ongoing exchange of medical expertise across Europe and ensure quick access to the UK healthcare system be appropriately trained EU doctors

Ongoing access to the IMI (Internal Market Information) alert system, which enables regulators across Europe to send and receive alerts about doctors’ fitness to practise across the EU

The retention of measures to protect public health standards, including those affecting food, alcohol, air quality, and tobacco regulations

An agreement between the UK and the EU to continue to share data and emergency preparedness planning in relation to cross-border threats

Ongoing access to EU research programmes and research funding

Immediate certainty for UK researchers who currently access Horizon 2020 funding about funding and collaboration on existing and future research projects

Continued access to the European Investment Bank to fund research programmes

Ongoing access to and participation in the European Reference Networks, enabling healthcare providers across Europe to tackle complex or rare medical conditions requiring highly specialised treatment

Abolition of the charge to migrants from outside the EEA to use the NHS.

I look forward to your reply.

Kind regards,

Yours sincerely,

Public Meeting: “What will Happen to the Supply of Medicines after 31st Oct”

Please share. More details or press enquiries please get in touch

Leeds Hospital Alert have organised a public meeting on 17th October, 7.30pm at St. Margaret’s Parish Church ,Church Lane, Horsforth LS18 5LA

Everyone is concerned about the supply of medicines now and after 31st October. Please share the meeting details with everyone you know.